Health First’s Dr. Ken Tieu: Relief from Reflux Disease Starts with Spotting the Symptoms

Gastroesophageal reflux affects 1 in 5 Americans

Gastroesophageal reflux affects 1 in 5 Americans, and the symptoms range from chest pain to cough to tooth deterioration. At Health First, our reflux specialists offer state-of-the-art remedies, including surgeries for the most severe cases.

BREVARD COUNTY, FLORIDA – Remember the old antacid commercials? “Heartburn” was just around the corner from a spicy burrito and a stressful work shift. Stockbrokers and air traffic controllers gobbled chewable antacids by the fistfuls.

Well, acid indigestion is just one symptom of gastroesophageal reflux, which is trickier, more dangerous and more common than we think.

Reflux happens when your stomach contents come back up your esophagus (even into your mouth) because the muscle that closes your stomach off after swallowing is weak or the force on it too great. About 1 in 5 Americans suffer from gastroesophageal reflux disease, or GERD.

“In my office, we get a lot of referrals from other medical disciplines,” says Dr. Ken Tieu, a Health First General Surgeon specializing in reflux relief. “The problem is, people don’t correlate some of the symptoms with reflux disease.”

Here are four things to consider about GERD.

Symptoms

Acid indigestion as a sign of reflux is well-advertised, but did you know that pain is not always a symptom? For some sufferers, reflux takes place at night, lying down, and the signs are a dull soreness in the throat, and a request from the dentist to get checked out because of tooth enamel deterioration.

Other symptoms of reflux include a persistent cough, belching, nausea, regurgitation or difficulty swallowing.

“More than half of the people who present at any hospital Emergency Department with chest pain aren’t having a heart attack, and many of the people going to the pulmonologist for frequent bronchitis, who get pneumonia frequently, these people are reflux disease sufferers. And then, you may not have any of those symptoms and still have the disease,” Dr. Tieu says.

Solutions

Some of the first solutions your doctor may discuss with you should you be found to have mild to moderate reflux is lifestyle changes.

Doctors may talk to you about sleeping slightly upright. They may suggest more frequent but lighter meals. They may highlight foods that should be cut or cut out, such as coffee and chocolate, carbonated beverages, peppermint and grapefruit, and red sauces. Of course, alcohol and tobacco are both substances that induce or exacerbate reflux.

A leading factor contributing to reflux is heightened intraabdominal pressure. How does that happen? Weight gain. Also, eating too much in a single sitting – those belt-loosening meals – or too late at night.

Diagnosis and Drug Treatments

Traditionally, an endoscopy is ordered up for anyone suspected of suffering from reflux disease. At Health First as well as other treatment centers, a Bravo PH probe sends readings back wirelessly to a monitor the patient wears for a day or more. Another, more traditional way, is to measure PH through a catheter that travels through the nose and down the esophagus.

Dr. Tieu says a trial run of pharmaceutical treatments such as proton pump inhibitors (or PPI, such as omeprazole (Prilosec) or esomeprazole (Nexium)) is also effective at ruling in reflux and ruling out an adjacent malady such as gastroparesis, a condition that inhibits the stomach from properly emptying, or achalasia, a rare condition that prevents nourishment from passing into the stomach.

More advanced treatments

Some patients require more intensive treatments, and that’s where Health First’s reflux specialists come in.

One surgical option is the Nissen fundoplication. In that, the top of the stomach is wrapped around the sphincter. This surgery has been done for about 70 years now with good results – about 4 in 5 patients are satisfied, their symptoms go away and they go off their reflux meds – but some patients find they cannot belch or vomit after these procedures. And Nissen fundoplication often doesn’t hold forever.

More recently, the LINX® Reflux Management System installs a magnetic bracelet around the sphincter, and the magnetic force closes the sphincter after eating, though it is not powerful enough to prevent food and drink from entering the stomach.

“We’re one of the only people in Central Florida who do this. It’s getting more and more mainstream, but we began doing it seven years ago. It’s given us better results. About 9 in 10 patients, their symptoms go away and they’re off their PPIs. There are fewer side effects. We’re not altering the stomach anatomy. And there’s greater durability after about 10 years of data.”

There are endoscopic options as well, such as the Stretta device that delivers low-frequency energy to strengthen the sphincter.

But for reflux disease sufferers with a body-mass index greater than 35, the recommendation is gastric bypass.

“The success rate for gastric bypass for reflux is super high. We’re talking over 90% success.”

Ultimately, Dr. Tieu recommends that anyone who suspects they may have a reflux disorder, even one that’s infrequent, ask their doctor about it. For those who suffer with it regularly, ask about permanent solutions.

“There are people who should be candidates for surgery, but they don’t get offered it because they don’t inquire. They say, ‘Oh, I didn’t know it can be fixed.’

“We’re trying to get the word out.”

To schedule an appointment or take a free reflux assessment, visit HF.org/reflux.

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